“All Americans should have access to health care,” according to Sen. Joe Biden. The key word in that statement is “access.” Unlike most other Democratic presidential candidates, Sen. Biden would not mandate universal health coverage. Nor would he replace or diminish the role of employer-based programs.


Published 1/1/2008

Where do they stand on health care?

By Annie Hayashi, Jennie McKee, Peter Pollack, and Carolyn Rogers

In our third report on presidential candidates and their stances on healthcare issues, AAOS Now examines the proposals put forth by Sen. Joe Biden, D-Del.; former Sen. John Edwards, D-N.C.; Sen. John McCain, R-Ariz.; and former Sen. Fred Thompson, R-Tenn.

Information in this article is based on public documents and records; AAOS Now also contacted the candidates’ campaign offices, but was not always successful in obtaining replies to our inquiries.

Joe Biden: “Access” is the key

Sen. Joe Biden

Sen. Biden’s proposed C.A.R.E. plan includes the following four essential principles:

Cover all children. Sen. Biden would expand the State Children’s Heath Insurance Program (SCHIP) to include families with incomes up to 300 percent of the current federal poverty level ($61,950 for a family of four) and extend coverage to age 21. All families could buy into the program on a sliding-income scale.

Access for adults. Uninsured adults would be able to buy into an insurance program (on a sliding-income scale) that mirrors the Federal Employees Health Benefits Plan. For companies that buy into the plan, employers, employees, and the government would share the cost of the premium. Individuals age 55 to 64 could buy into the Medicare program; low-income individuals in this age group would receive a subsidy to buy in as well.

Reinsurance for catastrophic cases. A federal reinsurance pool would reimburse employers and insurers for 75 percent of catastrophic healthcare costs in excess of $50,000 per person. Participating employers must cover all employees and apply best practices to chronic disease management. Private insurers in the individual market must operate an effective, high-cost case management system.

Encourage prevention, modernization. Sen. Biden would use the following “sensible steps” to control healthcare costs: Increasing comparative effectiveness research; investing in information technology; requiring uniform billing and claims; negotiating for prescription drugs; and meeting the need for new health professionals.

To pay the estimated $110 billion a year required for his plan, Sen. Biden would roll back the Bush tax cuts, eliminate tax breaks on capital gains, and end the war in Iraq.

John Edwards: Universal healthcare through “shared responsibility
Former Sen. John Edwards believes that businesses, families, and governments all have a role in achieving universal healthcare coverage and establishing a better healthcare system.

Sen. John Edwards

The Edwards plan aims to make health care “more affordable and rational” and would require businesses and other employers to cover their employees or help finance their health insurance. It would also create new tax credits, expand Medicaid and SCHIP, reform insurance laws, and take steps to contain health care costs.

The plan also calls for the federal government to help states and groups of states create regional “health care markets,” non-profit purchasing pools that would allow health care consumers to choose from competing insurance plans. According to Sen. Edwards, these health care markets would increase choices among insurance plans, cut costs for businesses offering insurance, and give every American the bargaining power to choose an affordable, high-quality health plan. Deductibles and co-payments would be dependent on each person’s income level.

“All Americans should have access to health care,” according to Sen. Joe Biden. The key word in that statement is “access.” Unlike most other Democratic presidential candidates, Sen. Biden would not mandate universal health coverage. Nor would he replace or diminish the role of employer-based programs.
“We have to stop using words like ‘access to health care’ when we know those words mean something less than universal care,” he said. “Who are you willing to leave behind without the care he needs? We need a truly universal solution, and we need it now.”
“Controlling healthcare costs will take fundamental change—nothing short of a complete reform of the culture of our health system and the way we pay for it will suffice,” says his Web site. “Reforms to federal policy and programs should focus on enhancing quality while controlling costs.”
To provide healthcare for every American, Sen. Thompson plans to reform and update current government healthcare programs. He envisions “the realignment of programs and the creation of a system” where consumers are offered healthcare options based on their individual needs and those of their families.

Once the plan is implemented, all U.S. residents would be required to have insurance; those who refuse to pay for coverage would have their wages garnished or would be contacted by collection agencies.

By lowering administrative costs, making better use of technology, and using the most cost-effective drugs and treatments, Sen. Edwards says his plan would provide “a systematic approach [to health care] that doesn’t exist today.”

John McCain: High costs are the “fundamental problem”
A fourth-term Senator, John McCain calls rising costs the “fundamental problem” in the U.S. healthcare system. His solutions for repairing the problem tend to stress consumer responsibility, choice, and cost control.

Sen. John McCain

Sen. McCain supports Medicare reforms that would compensate providers for diagnosis, prevention, and care coordination, and eliminate payments for preventable medical errors or mismanagement. He does not, however, have a stated plan for addressing the flaws in the Medicare Sustainable Growth Rate formula.

An advocate for liability tort reform, he would support legislation to eliminate frivolous lawsuits and excessive damage awards. He also suggests the creation of a “safe harbor” for physicians who follow clinical guidelines and adhere to patient safety protocols.

Sen. McCain also hopes to increase competition, both among providers and alternative treatments. He advocates building national healthcare markets by allowing providers to practice nationwide. He also supports alternative delivery systems, such as retail clinics, which he says provide greater market flexibility in permitting appropriate roles for physicians, nurses, and nurse practitioners.

Finally, he supports increased transparency and consumer choice in health care. He believes that more information regarding cost, price, quality-of-care, and outcomes should be made available to consumers so that they can take on more responsibility for prevention and care.

Fred Thompson: Free-market solutions, individual needs
The former actor (“Law and Order”) and former senator from Tennessee, Fred Dalton Thompson believes that those who propose a “one-size-fits-all Washington-controlled program” for national healthcare “ignore the cost, inefficiency, and inadequate care that such a system offers.” He supports health insurance that is affordable and portable but wants coverage that “can be made available without imposing new mandates or raising taxes.”

Sen. Fred Thompson

By promoting cost-effective preventive healthcare, chronic-care management, and personal responsibility, Sen. Thompson believes the health of individual Americans will improve.

He is a strong proponent of using free-market solutions such as “increasing competition and consumer choice while streamlining regulations that benefit individuals and reduce costs for employers” to solve current healthcare problems.

Sen. Thompson would update and “modernize” the current healthcare delivery system—“encouraging the widespread use of clinical best practices, medical information technology, and other innovations.”

For more information:
Sen. John Edwards

Sen. John McCain: http://www.johnmccain.com

Sen. Fred Thompson: http://www.fred08.com